What is the role of corticosteroids in the treatment of multiple organ dysfunction syndrome (MODS) in sepsis?

Updated: Jan 27, 2020
  • Author: Ali H Al-Khafaji, MD, MPH, FACP, FCCP, FCCM; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

The following key points summarize current use of corticosteroids in septic shock:

  • Older, traditional trials of corticosteroids in sepsis probably failed to show good results because they used high doses and did not select patients appropriately

  • Subsequent trials with low-dose (physiologic) dosages in select patient populations (vasopressor-dependent patients and those with potential relative adrenal insufficiency) reported improved outcomes

  • Corticosteroids should be initiated for patients with vasopressor-dependent septic shock

A cosyntropin stimulation test may be useful to identify patients with relative adrenal insufficiency, defined as failure to raise levels above 9 µg/dL.


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